Provider Demographics
NPI:1114009230
Name:PALANISAMY, AKILESH (MD)
Entity Type:Individual
Prefix:
First Name:AKILESH
Middle Name:
Last Name:PALANISAMY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 CALIFORNIA ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2753
Mailing Address - Country:US
Mailing Address - Phone:415-600-3503
Mailing Address - Fax:
Practice Address - Street 1:2300 CALIFORNIA ST
Practice Address - Street 2:#103
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2753
Practice Address - Country:US
Practice Address - Phone:415-600-3503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91569207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A915690Medicaid
CA00A915690Medicare PIN
CA00A915690Medicaid